Humeral nail

ABSTRACT

A humeral nail for the surgical care of fractures of the proximal humerus, with a shaft which has a longitudinal axis and is provided in a proximal portion with at least transverse bores spaced apart in the axial direction. The axis of the three bores are circumferentially offset in respect to each other in planes perpendicular to the longitudinal axis of the shaft. The nail is provided with at least two additional transverse bores in a portion located towards the distal end of the nail, the proximal transverse bore running diagonally to the longitudinal axis and being located in the same plane as is the axis of the additional transverse bores.

BACKGROUND OF THE INVENTION

The invention is related to a bone nail having a plurality of transversebores at one end thereof. More particularly, it relates to a humeralnail having a plurality of holes being angularly offset, both in a planeperpendicular to the nail axis and at an angle to that plane. It isknown that fractures of the humerus often occur in the proximal region,particularly in the head region of the humerus. For the surgical care ofsuch fractures, it is already known to provide a so-called locking nail.Preferably, the nail is driven into the humeral channel from theproximal to the distal direction. The nail is provided with lockingbores in the proximal region as well in the distal region, through whichbone screws are guided in order to secure the locking nail against axialdislocation and torsion. The bone screws in the proximal region servealso for the fixing of bone fragments.

A humeral nail of the described type has become known from U.S. Pat. No.5,472,444. This nail is provided with an oblong shaft and has fourtransverse bores in the proximal region, which bores are disposedaxially spaced apart and angularly offset from each other, in thecircumferential direction. The nail shaft is also bent.

SUMMARY OF THE INVENTION

The present invention has as one object to improve a humeral nail of thetype described in U.S. Pat. No. 5,472,444 to the effect that an evenmore effective guiding of the nail or the fracture fragments,respectively, can take place.

In the humeral nail of the present invention, the proximal transversebore, i.e. that one which is situated closest to the proximal end, hasan axis disposed diagonally to the longitudinal axis of the nail shaft.

In a humeral nail inserted in the proximal direction into the humerus,the nail sits on the outer side of the humerus head, and the transversebores in the proximal portion are arranged such that the locking screwscan be screwed into the humeral head from different directions. In theinventive nail, the diagonal arrangement of the proximal most transversebore is such that the bone screw is screwed in from the outside towardsthe inside diagonally downwardly (distally). Through this, the bonescrew is arranged in an anatomically more favorable fashion, because bydoing so the transmission of force to the nail is configured in a morefavorable manner. In addition, the bone screw can obtain a greaterlength, because it can be put into the humeral head across a greaterlength. Thus, added together, the surgical care of fractures in the headregion of the humerus is improved by the features of the nail of thepresent invention.

According to one embodiment of the invention, the inclination of theaxis of the proximal most transverse bore with respect to thelongitudinal axis of the nail shaft is at an angle of about 80°.

As already mentioned, several transverse bores are provided in theproximal portion of the nail shaft. According to one embodiment, theaxis of the distal most transverse bore in the proximal portion, i.e.that transverse bore which has the greatest distance from the proximalend of the nail shaft, is also disposed diagonally with respect to thelongitudinal axis of the nail shaft. The angulation is such that theaxis of the proximal and the distal transverse bores converge anddiverge, respectively. Preferably, the bores are directed into oppositedirections, i.e. one angled upwardly and one downwardly. This measure,too, proves to be extremely advantageous in fractures of the humeralhead, because even here the bone screw can be selected to be longer andcan be put into the endangered regions of the humerus head moreeffectively.

According to one embodiment of the invention, the angular offset of thedistal transverse bore with respect to the proximal transverse bore isapproximately 25°, this offset being preferably directed into thedirection opposite to the offset of that one transverse bore whichfollows the proximal transverse bore.

Preferably, four transverse bores are provided in the proximal portion,the two middle bores preferably running with their axis perpendicular tothe longitudinal axis of the nail shaft. The distal most bore in theproximal portion and the adjacent more proximal bore arecircumferentially offset by about 90°.

According to another embodiment of the invention, the nail shaft can besolid rather than cannulated. According to a further embodiment of theinvention, the nail has two distal bores one of the two distaltransverse bores is constructed as an elongated (oblong) hole orientedparallel to the longitudinal axis in the distal region.

With a straight shaft, it is necessary that two separate humerus nailsbe provided for the left and the right humerus. According to oneembodiment of the invention, except for the proximal most transversebores, the remaining transverse bores are provided in a differentarrangement for the left and the right nail shaft, the two arrangementsbeing indeed similar with respect to the axial distance and the relativeangular position, but being rotated by 180° with respect to thelongitudinal axis.

BRIEF DESCRIPTION OF THE DRAWINGS

One example of the invention will be explained in more detail by meansof drawings.

FIG. 1 shows the longitudinal view of a humeral nail for the righthumerus in a side view;

FIG. 2 shows the side view of the nail according to FIG. 1, rotated by90°;

FIG. 3 shows a section through the nail according to FIG. 1 along theline 3-3; and

FIG. 4 shows the side view of an inventive humeral nail for the lefthumerus in a view analogous to FIG. 2.

DETAILED DESCRIPTION

Referring to FIGS. 1 to 3, there is shown a preferred humeral nail 10for the right humerus. It has a straight shaft with a proximal end 12and a distal end 14. The nail 10 is put into the humerus from theproximal direction and serves for the surgical care of fractures in theproximal region of the humerus (not shown). The nail 10 is constructedas a locking nail having cross-bores for receiving locking screws.

The nail shaft has a longitudinal axis 15 and has a proximal portion 16,which extends distally to a point 18. In the preferred embodiment, theproximal portion 16 has a constant diameter. Beginning withcross-section 18, which can be preferably formed as a relatively smoothtransition, a relatively short conical portion 20 follows, and in turnis followed by a further conical portion 22. From cross-section 24 atthe distal end of conical portion 22, the nail shaft extends up to thedistal end 14 approximately with the same smaller diameter. The distalend portion 26 being again formed conically or spherically.

In the preferred embodiment, proximal end 12 is provided with threetransverse slits 28 running perpendicular to the longitudinal axis ofthe nail shaft, which cooperate with corresponding projections in adevice (not shown) for aiming and hammering in the nail. Slits 28 allowthe nail 10 to be accommodated in the proper angular position by thedevice.

In the preferred embodiment, proximal portion 16 has four transversebores 31, 32, 34 and 36. The axis of the middle bores 32, 34 extendperpendicular to the longitudinal axis of nail 10, but are rotated by115° with respect to each other. In the preferred embodiment, the axisof proximal transverse bore 30 is disposed diagonally to thelongitudinal axis, e.g. at an angle of approximately 80°, i.e. rotated10° with respect to a plane perpendicular to the longitudinal axis 15.The proximal transverse bore 30 partially intersects an axial bore 40 ofnail 10, which serves for the connection with the device (not shown) forinsertion and aiming.

Bore 32 following as the next one to proximal bore 30 is located on thecircumference offset with a certain angle of preferably 25°. This offsetis easily seen in FIG. 1. The distal transverse bore 36 also runsdiagonal to the longitudinal axis of the nail 10 with its axis, e.g. inan angle of 75° (i.e. rotated 15° with respect to a plane perpendicularto longitudinal axis 15) with the axis of transverse bores, 30, 36converging and diverging, respectively on opposite sides of nail 10. Inaddition, the axis of distal transverse bore 36 is rotated with respectto proximal transverse bore 30 in the circumferential direction, againat approximately 25°. The rotation with respect to the transverse bore32 takes place in the opposite direction, however, which again emergesfrom FIG. 1.

The transverse bores 30 to 36 serve for the accommodation of bone screws(not shown), which are screwed into the humerus head via the hard outerlayer of the humerus. For locating transverse bores 30 to 36, acorresponding aiming device (not shown) is required. The offset in thecircumferential direction of the transverse bores with regard to eachother enables the arrangement of the bone screws from out differentdirections, in order to provide surgical care to the correspondingfractures in the humerus head in an optimal manner. The diagonalarrangement of the transverse bores 30 and 36 enables an even moreoptimal care of fractures, with better transmission of force from thebone to the nail and reversely. In addition, the diagonal arrangement oftransverse bores 30 and 36 enables the use of particularly long bonescrews, without which the danger exists that the humerus head might bepushed through. In the preferred embodiment, bores 32 to 36 are providedwith a thread, which corresponds to the locking or bone screws. Throughthis, an unintended drifting out of the screws is prevented.

In the preferred embodiment, portion 27 of nail 10 has two transversebores 42, 44 are provided at a relative distance to distal end 14. Theaxis of the bores lay in one plane in which plane the axis of theproximal transverse bore 30 is also situated. This plane containslongitudinal axis 15 of the shaft. The distally positioned distaltransverse bore 44 may be in the form of an elongated hole, which can berecognized particularly from FIGS. 1 and 3. The transverse bores 42, 44serve for the accommodation of bone screws for the bracing of nail 10 inthe humerus shaft.

As already mentioned, nail 10 according to FIGS. 1 to 3 serves for thesurgical care of fractures in the right humerus. A nail 10 a for theleft of the humerus is represented in FIG. 4 and the shaft is formedidentically to the shaft of nail 10 according to the FIGS. 1 to 3. Forthat reason, the shaft will not be discussed further in detail inconnection with nail 10 a, except for the proximal portion 16 a, whichalso has four transverse bores 30 a, 32 a, 34 a and 36 a. Theconstruction of the transverse bores 30 a to 36 a again resembles thoseaccording to FIGS. 1 to 3. Even the position of the proximal transversebore 30 a is identical to the transverse bore 30 according to FIGS. 1 to3. Only the arrangement of the transverse bores 32 a to 36 a isdifferent to that one according to FIGS. 1 to 3, in that thisarrangement is mirror-like with respect to that one according to FIG. 2.The different arrangement at nail 10 a results purely from the fact thatthe nail 10 a is used for the left humerus. Thus, with respect to thehumerus to be applied, i.e. the left or right one, the arrangement ofthe transverse bores 30 to 36 and 30 a to 36 a are identical. The bores30, 32, 34 and 36 for either the left or right versions may be threadedto correspond to the threads of a locking screw. The nail shaft 10, 10 amay either be straight or curved. If the nail is curved, then theangular relationships would be with respect to the longitudinal axis atthat part of the shaft, i.e. proximal or distal.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

1. A humeral nail for the proximal humerus comprising a solid shaft having a longitudinal axis and having a proximal portion with at least three axially threaded transverse bores spaced alone the longitudinal shaft axis, each bore having an axis, which axes are circumferentially angularly offset from each other about the longitudinal shaft axis, at least two of the proximal transverse bores extend at a non-perpendicular proximal-distal angle to the longitudinal axis of each shaft and at least one bore extends perpendicularly to the longitudinal axis.
 2. The humeral nail as set forth in claim 1 wherein the axis of the proximal most transverse bore extends at a proximal-distal angle to the longitudinal axis.
 3. The humeral nail as set forth in claim 2 wherein the axis of the distal most transverse bore in said proximal portion runs at a proximal-distal angle to the longitudinal axis oriented with respect to the angle of said proximal most hole axis such that the axes of the proximal and distal transverse bores converge.
 4. The humeral nail as set forth in claim 3 wherein the axis of the distal most transverse bore is at an angle of approximately 75° to the longitudinal axis and the angle of the proximal most hole is approximately 80°.
 5. The humeral nail as set forth in claim 4 wherein the circumferential angular offset between the distal most transverse bore with respect to the proximal most transverse bore is approximately 25°.
 6. The humeral nail as set forth in claim 1 wherein four transverse bores are provided in the proximal portion of the nail shaft.
 7. The humeral nail as set forth in claim 6 wherein the transverse bore adjacent the proximal most transverse bore is oriented with its axis approximately perpendicular to the longitudinal axis.
 8. The humeral nail as set forth in claim 6 wherein the transverse bore adjacent the most distal transverse bore in the proximal portion is oriented with its axis approximately perpendicular to the longitudinal axis.
 9. The humeral nail as set forth in claim 6 wherein the angular offset between the transverse bore adjacent the proximal most transverse bore and the proximal most bore is approximately 25°.
 10. The humeral nail as set forth in claim 9 wherein the angular offset between the transverse bore adjacent the distal most bore and the distal most bore in the proximal portion is approximately 90°.
 11. The humeral nail as set forth in claim 10 wherein the angular offset of the two bores adjacent the proximal most transverse bore and the distal most transverse bore is 90°.
 12. The humeral nail as set forth in claim 6 wherein the shaft has a distal portion with two transverse bores, the distal most transverse bore is formed as an elongated hole elongated in a direction parallel to the shaft longitudinal axis in the distal region.
 13. The humeral nail as set forth in claim 1 wherein the thread of the transverse bores corresponds to the thread of a locking screw.
 14. A nail for insertion into a long bone having first and second ends with a longitudinal axis extending between said first and second ends comprising: a solid shaft, and at least three threaded cross-bores located along the longitudinal nail axis adjacent said first end, each of said cross-bores having a bore axis oriented at a different circumferential angle with respect to said longitudinal axis and at least two of said cross-bores having a bore axis oriented at non-perpendicular angles with respect to said longitudinal nail axis.
 15. The nail as set forth in claim 14 wherein the axis of one of said at least three cross-bores is oriented perpendicular to said longitudinal axis.
 16. The nail as set forth in claim 15 wherein there are four cross-bores.
 17. The nail as set forth in claim 16 wherein the nail axes of two cross-bores are oriented perpendicular to the longitudinal axis.
 18. The nail as set forth in claim 14 further including a pair of cross-bores located adjacent said second end of said nail.
 19. The nail as set forth in claim 18 wherein the axes of the two bores adjacent said second end lie in the same plane as a plane containing the axis of the cross-bore closest to the first end of the nail.
 20. The nail as set forth in claim 14 wherein the axes of said at least two cross-bores oriented at a non-perpendicular axis to said longitudinal axis are oriented at diverging angles. 